Inappropriate antibiotic prescribing patterns of clinicians continue to contribute to the global problem of antimicrobial resistance. The goal of this study, Electronic Communication for Antimicrobial Management (ECAM), is to improve the appropriate andjudicious use of antibiotics in the neonatal intensive care unit (NICU) by developing and testing an automated methodto remind clinicians to stop or change inappropriate antibiotics. The method will provide clinical decision support (CDS) within a computerized provider order entry (CPOE) system. Specific aims of ECAM are to: (1) define the data elements, logic, timing and method for clinical decision support for antibiotic prescribing within the workflow of the NICU and to implement the prototype CDSrCPOE system; (2) evaluate the CDS-CPOE system for violation of usability principles and to evaluate perceived usefulness, ease of use and intention to use the CDS-CPOE for antibiotic prescribing in two NICUs; and (3) examine the relationships between end-user characteristics and perceived usefulness, perceived ease of use and intention to use the CDS-CPOE for antibiotic prescribing in two NICUs. Despite the movementtowards use of CDS and CPOE systems and the growing use of computers in healthcare, the use of CDS for antimicrobial managementwithin a CPOE system has not been studied extensively. The Centers for Disease Control and Prevention has released a 12-step program to prevent antimicrobial resistance. Recommendations related to prescriber behavior that are particularly well suited to receive computerized CDS include: 1) target the pathogen; 2) use local data; 3) know when to say NO (e.g., to vancomycin); and 4) stop treatment when infection is cured or unlikely. The ECAM study will target these steps by identifying relevant data and defining the logic, timing and method for decision support for antibiotic prescribing within CPOE and within the prescribers' workflow. The System Development Life Cycle, a six phase process that uses continuous feedback from key individuals to guide the computer programming and design decisions, serves as the framework for this project. We will use ethnographic, qualitative and descriptive research methods to develop, test and evaluate the perceived ease of use and usefulness of a prototype CDS-CPOE for antibiotic prescribing in two randomly assigned NICUs which are part of the a randomized clinical trial being proposed in our Consortium for Interdisciplinary Research to Prevent Antimicrobial Resistance, CIRAR (Saiman, component 5 of 9). We hypothesize that providing decision support that targets the CDC 12-steps for antimicrobial management may improve prescribing practice and thus may help to reduce antimicrobial resistance.